Healthcare Provider Details

I. General information

NPI: 1245752468
Provider Name (Legal Business Name): TAYLOR CALLAHAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2017
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1771 TATE BLVD SE STE 101
HICKORY NC
28602-4250
US

IV. Provider business mailing address

1771 TATE BLVD SE STE 101
HICKORY NC
28602-4250
US

V. Phone/Fax

Practice location:
  • Phone: 828-304-2535
  • Fax:
Mailing address:
  • Phone: 828-304-2535
  • Fax: 828-256-1601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-09922
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: